区段肝蒂肝切除术与B超引导下肝切除术治疗肝胆管结石患者临床价值分析

Clinical value of segmental pedicle hepatectomy and B-ultrasound-guided hepatectomy in the treatment of patients with hepatolithiasis

目的研究区段肝蒂肝切除术与B超引导下肝切除术治疗肝胆管结石患者的临床价值。方法2014年12月~2017年12月我院收治的80例肝胆管结石患者被随机分为观察组和对照组,每组40例,分别接受区段肝蒂肝切除术和B超引导下肝切除术。术后随访7个月。结果观察组术中出血量为(350.4±105.7)mL,显著少于对照组【(489.6±154.6)mL,P<0.05】,术后肝断面引流量为(280.4±78.2)mL,显著少于对照组【(365.7±116.4)mL,P<0.05】,儿两组手术时间、术中输血量、排气时间和术后住院日比较,差异均无统计学意义(P>0.05);术后2周,观察组血清谷草转氨酶为(54.6±15.2)IU/L,显著低于对照组【(80.6±21.1)IU/L,P<0.05】,谷丙转氨酶为(87.2±28.1)IU/L,显著低于对照组【(121.3±30.8)IU/L,P<0.05】,谷氨酰转肽酶为(197.6±65.3)IU/L,显著低于对照组【(269.9±87.6)IU/L,P<0.05】,碱性磷酸酶为(216.9±77.4)IU/L,显著低于对照组【(312.3±95.6)IU/L,P<0.05】;观察组结石残留率为7.5%,显著低于对照组的40.0%(P<0.05);观察组术后并发症发生率为25.0%,显著低于对照组的55.0%(P<0.05)。结论与B超引导下肝切除术比,采取区段肝蒂肝切除术治疗肝胆管结石患者具有出血量少、术后并发症少的优势,有利于保护肝功能和术后恢复。

Objective In order to compare the clinical value of segmental pedicle hepatectomy and Bultrasound-guided hepatectomy in the treatment of patients with hepatolithiasis.Methods 80 patients with hepatolithiasis were recruited in our hospital between December 2014 and December 2017,and were randomly divided into observation and control groups,with 40 cases in each,receiving segmental pedicle hepatectomy and ultrasound-guided hepatectomy,respectively.All patients were followed-up for seven months.Results The amount of hemorrhage in observation group was(350.4±105.7)mL,significantly lower than[(489.6±154.6)mL,P<0.05]and the postoperative volume f drainage was(280.4±78.2)mL,significantly lower than[(365.7±116.4)mL,P<0.05]in the control,while there were no significant differences as compared to the operation time,intraoperative blood transfusion volume,postoperative exhaust time and postoperative hospital stay in the two groups(P>0.05);two weeks after operation,serum glutamyltransferase level in the observation was(197.6±65.3)IU/L,significantly lower than[(269.9±87.6)IU/L,P约0.05]and serum alkaline phosphatase level was(216.9±77.4)IU/L,much lower than[(312.3±95.6)IU/L,P约0.05]in the control;the incidence of postoperative complications in the observation group was 25.0%,significantly lower than that in the control group(P<0.05).The incidence of postoperative complications in the observation group was 25.0%,significantly lower than 55.0%in the control group(P<0.05).Conclusion The application of segmental pedicle hepatectomy for the treatment of hepatolithiasis has the advantages of less bleeding,fewer complications,and rapid recovery.